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Department of Environmental Management <br /> Wastewater Division, County of Hawaii <br /> Application For Sewer Extension <br /> Part A. (must be completed) <br /> Project Address: Date: March 29, 2012 <br /> TMK No.: 2-4-1: 177 <br /> Applicant Information: Contractor Information: <br /> Name: Keith Kato Name: Michael Singer <br /> Address: 100 Pauahi Street#204 Hilo, HI 96720_ Address: P.O. Box 1719 Keaau, HI 96749-1719 <br /> Company: Mohouli Senior Phase 1 LLLP Company: Heartwood Pacific LLC <br /> Phone No.:969-1158x105 Phone No.:327-6700 <br /> Check applicable box: ® Sewer Main Installation (Indicate reason for work and complete Parts B & C.) <br /> ❑ Sewer Lateral Installation (Indicate reason for work and complete Part C) <br /> Reason For Work: New 60 unit apartment complex <br /> Part B. <br /> Sewer extensions are subject to Hawai'i County Code, Chapter 21, Division 4, Extensions and the APPLICANT shall be <br /> responsible for submitting a final resolution to the Wastewater Division for review. The Department of Environmental <br /> Management will submit the final resolution and supporting documents to the County Council for approval of the sewer <br /> main extension. Select one of the following methods of payment for cost and construction: <br /> (Note: reimbursement refers to payments collected by the County from properties connecting to the extension) <br /> Section 21-28(a): Applicant constructs and pays. <br /> Section 21-28(b)(1): County constructs,applicant pays. ❑ <br /> Section 21-28(b)(2): County constructs, applicant and County share cost. ❑ <br /> Estimated Start Date May 1, 2012 Estimated Completion Date May 1, 2013_ <br /> Part C. <br /> I hereby certify that all work requested above will conform to appropriate sections of the Hawai'i County Code. <br /> Owner Signature: 4(1�1: Date: 3/29/2012 <br /> Department of Environmental Management, Wastewater Division <br /> Approved by: Date: =:Q t L <br /> Wastewater Division Chief <br /> Approved by: Date: <br /> Director o Environments Management <br /> Note: 1) Approval of the Application for Sewer Extension does NOT constitute approval for construction. <br /> Approval for construction is provided by an approved Permit to Perform Work on the Public Sewer <br /> System pending final approval by the Hawai'i County Council in accordance with Section 21-26.1 of the <br /> Hawai'i County Code. <br /> 2) Filing of Sewer Extension Resolution is not required for sewer lateral installations. <br /> Hawaii County is an Equal Opportunity Provider and Employer <br /> C:\Documents and Settings\Keith KatoWy Documents\Data\Mohouli Sr\HCB\Utilities-Wastewater\Sewer Extension Application(1).doc <br />